KSPACE SUMMER SCHOOL 2024

BOOKING FORM FOR RESIDENTS IN JAPAN

THIS IS A BOOKING FORM ONLY. FOR DETAILS ON FEES AND FOR MORE INFO. PLEASE CONTACT Kspace International School: enquiries@kspacetokyo.org

General Information
1) Are you an enrolled Kspace member?	No   Yes
2) Has your child ever attended a Kspace Spring/Winter/Summer School?	No   Yes
a)If 'Yes' to the above, please give details of programme
b)If you answered 'No' to the above, have you ever visited Kspace before?	No   Yes

Student's Information
Surname (family name) *
Forename (first name) *
Gender	Girl Boy
Date of birth (DD/MM/YY) for example born 25/Oct/2019 *	dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 M Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec yyyy 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 Please select date of birth
Nationality/Nationalities (on passport)
1st Language
Other Languages
English Language Level	Complete Beginner   Beginner   Intermediate   Advanced / Fluent
If your child has studied English before please tell us where/how:

Student's Medical Information	No	Yes (Please provide information)
Does your child have any physical challenges or limitations at all?	No	Yes
Does your child have any cognitive, behavioural or social challenges or limitations at all?	No	Yes
Does your child suffer from hayfever and do they ever take drugs for hayfever?	No	Yes
Does your child have asthma, and if so do they need an inhaler?	No	Yes
Does your child have any allergies at all? (state the allergy, its intensity and if they also require an Epi-Pen)	No	Yes
Has your child received all vaccinations recommended in Japan?	No	Yes
Does your child have any special diet (please list)?	No	Yes

Parent/Guardian Contact Information	Address in Japan
Please list the name of the primary English speaker in 'Parent A', if you have an English speaker in your family.
Parent A's Name (first name/family name) *
Relationship to Student
Nationality
Parent B's Name (first name/family name)
Relationship to Student
Nationality
Address
Postcode
Phone / landline
Mobile *
Email Address * Note: Please do not provide mobile phone provider email address

Summer School Uniform
Dress (number of items)	0   1   2   3   4   5
Shorts (number of items)	0   1   2   3   4   5
T.Shirt (number of items)	0   1   2   3   4   5

 

Please add a tick mark ( ✔ ) in the boxes on the dates/courses/times that you would like your child to attend.

To give you an accurate invoice please complete fields for every date that you want to book.

Booking Dates (Summer School - July 22nd to August 17th, 2024)
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
July 22 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	July 23 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	July 24 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	July 25 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	July 26 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	July 27 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
July 29 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	July 30 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	July 31 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	August 01 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	August 02 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	August 03 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
Aug 05 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 06 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 07 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 08 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 09 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 10 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
Aug 12 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 13 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 14 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 15 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 16 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 17 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm
Booking Dates (SUMMER SCHOOL EXTENSION - August 21st to August 30th, 2024)
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
AUG 19 School Closed	AUG 20 School Closed	Aug 21 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 22 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 23 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 24 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm
MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY
Aug 26 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 27 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 28 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 29 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm	Aug 30 Regular Programme 9.00am to 3.00pm After School 3.00pm to 4.00pm 4.00pm to 5.00pm Breakfast Club 8.00am to 9.00am Extension Hrs 5.00pm to 6.00pm 6.00pm to 7.00pm

 

IMPORTANT NOTES & AUTHORISATIONS

New students are required to take a paid trial at Kspace before summer school dates begin.

Parents must please read, accept and adhere to general school policies, which will be available in January 2024.

NOTE: Policies covering health and travel continue to be reviewed carefully and will not be finalised until later in 2024. Parents will receive full information in our Summer Starter Pack or by direct email. Additional, information might be required from parents re. a Travel and Health Disclosure prior to actual attendance.

---------------------------------------------------------------------------------------------------------------------------------------------------------

Parent/Guardian Online Signature

I am the parent/guardian and the information I have provided is correct.

I will read and adhere to all Kspace policies.

I understand that whilst at the School, photo/video footage is taken of the children for newsletters and promotion purposes, and that students cannot be segregated.

Type Name in full (first/ middle/family name) : 
Completing this field acts in place of your handwritten signature, in agreement with School policies and as a request for the booking listed above.

The data that you submit online will be treated and stored with absolute respect and confidentiality.

Date :

Enter The Given Code *: